This prefix is linked to an HMO plan. Health Maintenance Organization coverage requires members to use in-network providers and coordinate care through a designated primary care physician. Referrals are typically required for specialist visits. Claims submitted without proper referral documentation may be denied.
This prefix is associated with a High-Deductible Health Plan. HDHP members pay more out-of-pocket before insurance coverage begins. These plans are commonly paired with HSA or HRA accounts. When billing, be aware that the member may have significant cost-sharing responsibility until their annual deductible is satisfied.
POS (Point of Service) plans combine features of HMO and PPO coverage. Members choose a primary care physician and can get referrals to see in-network specialists at lower cost, or self-refer to out-of-network providers at higher cost. Claims should include referral information when the member uses the in-network benefit level.
State's only statewide customer-owned health insurer and independent licensee of the Blue Cross Blue Shield Association. Serves Illinois with commercial, Medicare, Medicaid and other plans.